Immigration Health Surcharge for Work Visa Holders

The Immigration Health Surcharge (IHS) is a mandatory fee charged by the UK government to most migrants, including work visa holders, as part of the visa application process. It is designed to contribute to the cost of using the National Health Service (NHS) and must usually be paid before the visa is granted. This article explains how the surcharge operates, who must pay it, when it applies, exemptions and reimbursements, and important compliance considerations for employers and visa applicants.

What Is the Immigration Health Surcharge?

The Immigration Health Surcharge (IHS) is a charge applied to many UK visa applications that are for more than six months' duration. Payment of the IHS provides the visa holder and any dependants with access to most NHS services on broadly the same basis as a UK resident. Without payment of the surcharge, a visa application that requires it will not be granted.

The surcharge is not a tax: it is a pre‑paid contribution to the NHS. Paying it does not guarantee free access to all healthcare services (for example, dental treatment and prescriptions may still incur charges), but it does cover most hospital and primary care services.

1. Who Must Pay the IHS?

Most individuals applying for UK immigration permission to live and work in the UK for more than six months - including work visas such as the Skilled Worker visa - must pay the surcharge. This applies to both:

• Main applicants; and
• Dependants applying alongside them.

If dependants are included in the visa application, the surcharge must be paid for each person separately.

Key rule: Payment is required for all visa applications that grant leave for more than six months unless the applicant qualifies for a specific exemption.

2. How Much Is the Surcharge and How Is It Calculated?

Standard Rates

The current standard IHS rate for most work visas is £1,035 per year of leave granted. For example:

• A Skilled Worker visa for three years would attract an IHS liability of £3,105 (3 × £1,035).
• If the visa covers part of a year, liability is calculated in six‑month blocks and rounded up to the nearest full six months.

Reduced Rate Categories

There is a reduced rate (£776 per year) for specific groups, primarily under other visa categories such as student visas or the Youth Mobility Scheme, and for children under 18 in those categories. Work visas generally attract the standard rate.

The IHS charge is calculated automatically during the online application process. If an application covers a period longer than one year, the system multiplies the appropriate annual rate by the number of years (and appropriate half years) of leave being sought.

3. When Must the Surcharge Be Paid?

The IHS must normally be paid as part of the visa application. UK Visas and Immigration (UKVI) will calculate the surcharge liability based on the length of leave requested and ask for payment before issuing a decision on the case.

If the surcharge is not paid when required, the application may be refused or delayed. For example, some applicants have reported payment links failing to appear during the application process, requiring follow‑up with UKVI to resolve before the application can progress.

4. What Does Payment Cover? Rights and Use of NHS Services

Once you have paid the IHS and your visa is granted, you are entitled to use the NHS in England for the duration of your immigration permission on a similar basis to someone ordinarily resident. This generally includes hospital treatment and GP services, though some items such as prescriptions, dental work and eye tests may still incur charges.

Importantly, this access begins from the start date of your visa. If UKVI has not yet decided your application, you may need to pay for NHS treatment until the visa start date is confirmed.

5. Exemptions and Reimbursements

Health and Care Visa Exemption

Applicants under the Health and Care Worker visa - a specific work visa category for medical and social care professionals - are exempt from paying the IHS. This exemption applies to both the main applicant and eligible dependants.

Reimbursement Schemes

Separate from exemptions, eligible health and social care workers not on a Health and Care Worker visa but who have worked in the sector may claim reimbursement for IHS paid back for prior periods, provided they meet continuous employment criteria within the NHS or social care (for example, working at least 16 hours per week for six months). Reimbursement claims are handled online and paid in instalments covering eligible periods.

Reimbursements may also be available in other limited circumstances, for example where dependants are refused visas after IHS has been paid, though the rules differ by scheme and application type.

6. IHS and Visa Extensions

If you extend your visa, you must generally pay the IHS again to cover the additional period of leave granted. The surcharge is assessed for the full period of new leave, including any overlap with previous leave.

The Home Office's caseworker guidance emphasises that the IHS liability is calculated for each immigration permission period and must match the length of leave shown on the Certificate of Sponsorship and online application. Failure to pay the correct amount can result in a requirement to top up the surcharge before the application is decided.

7. Practical Considerations and Compliance Issues

Who Pays the IHS?

Legally, it is the applicant who must pay the IHS as part of the visa application. There is no statutory requirement for employers to cover this cost, although some employers may choose to pay or reimburse the surcharge as part of relocation packages. The decision on who pays - employer or employee - depends on the contract of employment or relocation agreement.

Financial Implications

For long visas, the total IHS liability can be significant. For example, a five‑year Skilled Worker visa could attract more than £5,000 in IHS costs alone at £1,035 per year. This should be factored into financial planning when considering relocation or visa renewal.

Non‑Compliance Risks

Failure to pay the correct IHS amount or to pay it on time can delay the visa decision or result in refusal of the application. Discrepancies in dates between the Certificate of Sponsorship and the visa application can also affect the correct calculation of the surcharge.

8. Common Questions

Is the IHS refundable if my visa application is refused?
If your visa application is refused before a decision is made, you should not normally be charged the IHS. If the refusal occurs after payment and the visa was granted for a period you did not ultimately use, there are limited refund mechanisms, but these depend on specific circumstances and UKVI guidance. Some refund scenarios apply if dependants are refused while the main applicant is granted leave.

Does settling permanently (Indefinite Leave to Remain) mean I don't have to pay IHS?
Applicants granted indefinite leave to remain are exempt from needing to pay the surcharge for that grant of leave because they are no longer under temporary immigration control.

Does paying IHS mean I get private healthcare?
No. The surcharge covers NHS access only. Private healthcare services remain separate and require private insurance or out‑of‑pocket payment.

Summary

The Immigration Health Surcharge (IHS) is a mandatory contribution that most work visa holders - including Skilled Worker applicants and their dependants - must pay as part of their UK visa application. The standard rate for work visas is £1,035 per year of leave granted, with liability calculated in six‑month blocks. Payment allows access to most NHS services without charge at the point of use. Exemptions apply for Health and Care Worker visas, and certain workers may reclaim portions of the surcharge under reimbursement schemes. Correct calculation and timely payment are essential to avoid visa delays or refusals. Employers and applicants should plan for these costs, particularly when applying for long periods of leave or extensions.